Black Women's Perspectives on Structural Racism across the Reproductive Lifespan: A Conceptual Framework for Measurement Development

In a recent article in Maternal and Child Health Journal, Brittany D. Chambers, PhD and Monica R. McLemore, RN, PhD, FAAN, along with their colleagues, detail the results of the first study to develop a conceptual framework of structural racism from the perspectives of Black women across the reproductive lifespan in the field of maternal and child health.  

Exposures to structural racism has been identified as one of the leading risk factors for adverse maternal and infant health outcomes among Black women; yet current measures of structural racism do not fully account for inequities seen in adverse maternal and infant health outcomes between Black and white women and infants.  In the study, Black women residing in Oakland and Fresno, California identified nine unique domains of structural racism. The researchers’ findings highlight the complexities of structural racism previously measured in the research literature and provides more nuanced accounts of racism across the reproductive lifespan. 

“For too long, research has been focused on individual level factors that contribute to health disparities that are not helpful when attempting to address a complex issue like racism. It is essential that future research center the voices of people who experience the condition as they have unique perspectives on the harm, but also the solutions to mitigate these harms, ” said McLemore.

Overall, women defined structural racism as a system that distributed unequal access to resources and opportunity. Using these definitions, nine domains of structural racism emerged from women’s stories. Seven domains represented women’s experiences with structural racism across the reproductive lifespan: Negative Societal Views; Housing; Medical Care; Law Enforcement; Hidden Resources; Employment; and Education; while two domains were only representative of pregnant and postpartum women’s experiences: Community Infrastructure and Policing Black Families.  

Domains that emerged from this study both confirm and introduce novel domains of structural racism. Black women described structural racism as a system of oppression that showed up in their communities as negative societal views of Black people and women; hidden health and community resources; inadequate housing and medical care; harassment and discrimination from law enforcement and within employment and educational settings; deficits in community infrastructures to provide safe and healthy environments; and the policing of Black families in private and public spaces.  Two novel domains of structural racism emerged, the policing of Black families and hidden resources. There is a dearth of literature on how women in this study described hidden resources. Women in the study particularly described being policed by social services including CPS as a domain of structural racism.  

In addition, women confirmed pathways of structural racism identified by Krieger’s ecosocial theory, which provides a conceptual framework describing structural racism as a multifaceted construct encompassing concurrent and interacting pathways such as social and economic deprivation, exogenous hazards, social trauma, targeted marketing, ecosystem degradation and land alienation, responses to discrimination, and inadequate health care. Women described racial inequities in constructs of social and economic deprivation (e.g., system-based racial discrimination and devaluation in educational and employment opportunities and advancement), community infrastructure (e.g., food deserts and high crime rates in communities of color), and inadequate and inappropriate medical care (e.g., fragmented care and racially biased treatment options). 

These data support the importance of screening for social and structural determinants of health, especially when providing care to Black women across the reproductive lifespan. Black women also described issues with experiencing inadequate reproductive health care and low percentages of Black providers, suggesting the need for ongoing racial equity training for providers and diversifying the workforce. Lastly, findings from this study should be used to inform novel measurements of structural racism, and policy recommendations to improve predominately Black communities. 

Monica McLemore is a tenured associate professor in the Family Health Care Nursing Department, an affiliated scientist with Advancing New Standards in Reproductive Health, affiliated faculty with the Philip R. Lee Institute for Health Policy Studies and a member of the Bixby Center for Global Reproductive Health. She retired from clinical practice as a public health and staff nurse after a 28-year clinical nursing career. Her research is grounded in reproductive justice, a lens she uses to understand reproductive health and rights for people with the capacity for pregnancy. Her work is grounded in the hypothesis that if we center the most marginalized people, care improves for everyone.

Dr. McLemore conducts research across the reproductive spectrum including abortion, birth, cancer risk, contraception, family planning, and healthy sexuality, pleasure, and consent. Her work exemplifies the combination of nursing, public health, and policy research using community engaged and embedded methods to develop programs to test and deliver interventions.



Black Women's Perspectives on Structural Racism across the Reproductive Lifespan: A Conceptual Framework for Measurement Development

Chambers BD, Arega HA, Arabia SE, Taylor B, Barron RG, Gates B, Scruggs-Leach L, Scott KA, McLemore MR. Matern Child Health J. 2021 Jan 4. doi: 10.1007/s10995-020-03074-3. Online ahead of print.